Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Sunday, July 22, 2007

This time we recorded inside Clink's place, away from the buses and the birds and the helicoptors. I also did not use the GarageBand filter ("Female Radio") which I usually use to filter out low-volume background noises during silent periods. Let me know your thoughts about how it sounds. We are *thinking* about maybe getting lapel mikes and an inexpensive little mixer to balance out our voices better (any suggestions on products welcomed).

Also, we recorded this last weekend. Since it is a shrink rule that we must take off in August (I swear, they'll kick you out of the APA if you don't), we prerecorded two more podcasts (actually, more like one-and-a-half) which I will dribble out over the next few weeks, but we will return with fresh bloviating blather towards the end of August. (Can't wait? Listen to some old My Three Shrinks.)July 22, 2007: #29 Suicidal Breast Implants

Topics include:

Brief discussion about iTunes. We hit #6 in the Medicine section in iTunes last week, thanks in part to KevinMD blogging about our last podcast. We are now getting about 8-9000 podcast downloads per month, which we all find rather amazing. Of course, after the U.S., the country we get the most hits from is China, so we figure there must be Chinese people somewhere trying to learn English from us (big mistake). For the handful of psychiatrists out there (Chinese or otherwise), perhaps we'll release one of those Dummies books about how to make podcasts.

You're Supposed to Get Better. Dinah's post about how to know when you are making progress in therapy, and when to move on. (On the blog, this led to a series of emotional posts and comments about therapy, the power inequity between therapist and patient, and the differences between docs blogging about pts and vice versa. Go here, here, and there to read more.)

Cosmetic Breast Augmentation and Suicide. Dinah reviews this article from the July issue of AJP, from David B. Sarwer, et al., which finds "Across the six studies, the suicide rate of women whoreceived cosmetic breast implants is approximately twice theexpected rate based on estimates of the general population." I guess we need a black box warning on silicone breast implants now. (We had a post a year ago about the Good Breast; this one is obviously the Bad Breast.)

Q&A: "Is chronic antidepressant use harmful in the long term?" We don't really do this topic justice, but Dinah refers to a prior post here.

Coming up on the next podcast: 3 AJP articles on suicide and depression treatment; federal parity laws; managing agitated patients in your office.

I haven't been able to get this song out of my head for the last 2 weeks (prompting me to get the song from iTunes and then buy the CD), so I thought I'd share the infection with everyone: Mr. Blue Sky by Electric Light Orchestra (ELO). For a really cute video of this song, check out CurlyLisa's gang on YouTube.

Clink: I received that book the same year I asked for a library-worthy dictionary. 16 maybe? Nerd alert.

Roy: Are you big into biking? If so, I only just figured that out. I thought you were just being weird.

Re Ambien, wow, that's some great stuff. Started it when I was hyperthyroid...and for the first time in my life I can actually sleep when I go to bed. Doesn't sound that exciting, but no longer do I have to try to function on 2 hours of sleep on a big day. I never realized how much insomnia impeded my life until now, or how lucky some people are.

And how you can really determine whether people were eating the buttered cigarettes? I mean, has Clinton ever used Ambien? Maybe he really did tell the truth as he knew it, and maybe same with Iran-Contra. Now there's an ethical issue: do we let people with access to warheads/guided missiles use drugs that can cause blackouts (or is there a difference between sleep-orating and a blackout? [the neurologist, not Bill (please help me stop!)])?

Re "so-called SSRI" risks, I've seen headlines for correlations with diminished bone density in several different science news sources recently. Maybe you mentioned it and I just missed it, but a 6000-man cross-sectional and a 2700-woman longitudinal study seems fairly substantial. I wonder if the TCA outcome at all bolsters the case for causation?

Different source: Researchers studied 2,722 women with an average age of 78, following them for an average of 4.9 years. SSRI users had an average hip bone density decrease of 0.82 percent a year, compared with 0.47 percent a year in nonusers. Decreases among women who used tricyclic antidepressants...were the same as among those who used no antidepressants.

In a second study, of 5,995 men 65 and older, bone mineral density was 3.9 percent lower at the hip and 5.9 percent lower at the lumbar spine... In that study, however, only 160 men were using SSRIs, a percentage smaller than in the general population, and the results are based on a single analysis, not progression over time.Don't see how long they used them though, and this doesn't really say anything about people under 65 (men=65+, avg. age women=78).

Great blog! Thanks. I recently had lasik surgery and by accident I stumbled upon www.thepatientsadvantage.com. I used them when looking for a lasik surgeon. What I liked the most was that my profile remained anynomyous until I was ready to decide what to do. I received replies from four surgeons that met all the things I was looking for. I liked having that complete control without the sales pressure that some of these places can be known for. If you are going to go down the cosmetic surgery road...better to be safe than sorry. Check them out.

I have become very interested in Body Dysmorphic Disorder. Look up Lolo Ferrari (deceased, possibly suicide) on Wikipedia. Very sad. There is a NSFW pic of her, but, honestly, her breasts are so huge they don't even look like breasts. I also look at some male stars and wonder how many men have it and how much that instance has risen.

SSRI's: If you're going to kill yourself anyway, isnt taking an SSRI worth taking even if there are long term issues?

I know lithium is not an SSRI but I take it for suicidality and I HATE LITHIUM!!!!!!!!!!! It has however, taken away that suicidal intensity I had last year.

I'm going to have to start taking notes during podcasts because I forgot what I wanted to say.....

And what do I say? "You win some, you lose some?" Or "Was it a chemical imbalance? Were they undergoing treatment? Were there any signs?" Or perhaps "You stupid, stupid, selfish people, I know those with real problems worse than yours, and they survive! This was a permanent solution to a temporary problem, you Idiots!"

But it's too late to say anything, they can't hear me.

Move along, nothing to see here.

I'm very glad I'm not a psychiatrist. If I can't keep boundaries between myself and total strangers on the other side of the planet, how could I during therapy with a patient?

Thanks for doing what you do, Oh Three Shrinks. It's a dirty job, but someone has to do it.

Hey there shrunken friends. I was wondering about podcasting. Clark Bartram (Unintelligent Design) and I have been batting around the idea of doing a podcast. Could one of you e-mail me (see my blog for the address) regarding how this is best done.